[Recognising and treating depression - a practical overview of current treatment algorithms and evidence-based...

Depressive syndromes are among the most common mental conditions in primary care. They are associated with high morbidity and relevantly reduced quality of life. General practitioners (GPs) play a central role in early detecting and diagnosing depression as well as in initial treatment. This paper summarises the new Swiss treatment recommendations and gives an overview of evidence-based treatment algorithms with a focus on applicability in primary care. Diagnosis is based on core symptoms of depression. In addition to a structured anamnesis, validated instruments for screening and development of symptoms should be used. Further, somatic causes should be excluded using basic laboratory tests and, if indicated, neuroimaging. Treatment depends on the severity of depression: In mild depression, active monitoring, low-intensity interventions (e. g. self-help strategies, activation, sleep and circadian strategies, physical activity, etc.) and psychotherapy are indicated. In moderate episodes, psychotherapy or antidepressants are indicated; severe episodes require a combination of psychotherapy and antidepressants. First-line antidepressants are SSRIs and SNRIs and other modern antidepressants. In case of non-response, a combination of antidepressants or augmentation with atypical antipsychotics or Lithium is recommended. Psychotherapy has proven efficacy across all severity levels, and it should be combined with antidepressants in severe episodes. In severe, psychotic and difficult to treat depressive episodes, strategies from the field of interventional psychiatry (ECT, rTMS, Esketamine) are effective. Complementary approaches such as physical activity/exercise, light therapy, or social therapy further enhance treatment outcomes. In conclusion, guideline-based multimodal care for patients starting in primary care improves outcome and prognosis for patients with depression and can reduce the risk of chronification and relapses. Key elements are structured diagnostics, early initiation of evidence-based therapy with regular valid monitoring within a strong doctor-patient-relationship.